Modeled Cost-Effectiveness of a Rideshare Program to Facilitate Colonoscopy Completion.

Importance: In colorectal cancer (CRC) screening, too many patients fail to receive follow-up colonoscopy after an abnormal fecal immunochemical test (FIT), and transportation is a frequently reported barrier.

Objective: To determine the outcomes and cost-effectiveness of providing a rideshare intervention to patients with abnormal FIT results.

Design, setting, and participants: The CRC-Simulated Population Model for Incidence and Natural History microsimulation model was used to simulate the outcomes and cost-effectiveness of a rideshare intervention to improve colonoscopy completion in a population-based CRC screening program. Cohorts were adherent to annual FIT-based screening; baseline analyses assumed that 35% would complete a follow-up colonoscopy. Data were analyzed from November 14, 2023, to July 8, 2025.

Intervention: A $40 or $100 rideshare to increase completion of follow-up colonoscopy.

Main outcomes and measures: Lifetime outcomes included the number of CRC cases, deaths, and life-years gained (LYG) per 1000 people screened and costs associated with improved completion of a colonoscopy after an abnormal FIT result.

Results: Four single-age cohorts (ages 45, 55, 65, and 70 years on January 1, 2024) of 10 million people each were simulated. In cohorts with similar sex distribution as the US population (aged 45 years, 50.0% male; aged 55 years, 49.4% male); aged 65 years, 48.0% male; and aged 70 years, 46.9% male), compared with no intervention, using a rideshare intervention starting at age 45 years that costs $100 per ride to increase colonoscopy completion from 35% to 70% was associated with a reduction in CRC cases per 1000 by 26.3% (30.7 vs 41.6 cases per 1000), CRC deaths per 1000 by 32.5% (9.8 vs 14.6 cases per 1000), 24.9 LYG per 1000, and at $100 per ride cost $43 308 per 1000 people screened and saved $330 587 per 1000 people screened.

Conclusions and relevance: In a microsimulation model, increasing colonoscopy completion in a population with abnormal FIT results via a rideshare intervention was cost saving up to $100 per ride due to the combined outcome of cancer prevention and early detection.